神经内镜与显微镜经鼻蝶入路切除巨大垂体腺瘤的对比分析  

Comparative analysis of neuroendoscopic and microscopic trans-nasal-sphenoidal giant pituitary adenomas resection

作　　者：周辉[1] 王志明[1] 蒲九君 钟艾凌 阮伦亮 靳凯[1] 杨刚[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《中国内镜杂志》2015年第8期785-789,共5页China Journal of Endoscopy

基　　金：重庆市科委自然科学基金(No:CSTC2013jcyj A10079);国家临床重点专科建设项目经费(No:财社[2011]170号)

摘　　要：目的对比分析神经内镜与显微镜经鼻蝶入路切除巨大垂体腺瘤的手术疗效及安全性。方法回顾性分析69例神经内镜和47例显微镜手术切除的巨大垂体腺瘤患者临床资料,两组均经鼻蝶入路,比较两组的肿瘤全切率、手术并发症、手术时间、术中出血量及住院时间。结果神经内镜组与显微镜组在肿瘤全切率、手术时间、术中出血量、住院时间、脑脊液漏发生率及颅神经损伤方面差异具有统计学意义(χ2=4.88,t=4.37,t=5.09,t=-3.42,χ2=4.07,χ2=5.40,均P<0.05),在术后新发垂体功能低下、术后尿崩发生率、嗅觉减退及鼻出血发生率观察指标方面组间比较差异无统计学意义(χ2值分别为1.17、1.76、0.03和0.31,均P>0.05)。结论神经内镜相比显微镜经鼻蝶入路切除巨大垂体腺瘤,可提高全切率,降低部分并发症并缩短住院时间。[ Objective ] To comparatively analyze the efficacy and safety of trans-nasal-sphenoidal giant pituitary adenomas resection under neuroendoseope or microscope. [Methods] Sixty-nine patients who underwent neuro-en- doscopic endonasal transsphenoidal surgery and 47 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received endonasal transsphenoidal approach. The clinical data of two groups were compared, which included total tumor removal rate, operative complications, opera- tion time, peri-operative bleeding volume and the length of hospital stay. [ Results ] Two groups were significantly different in total tumor removal rate, operation time, peri-operative bleeding volume, length of hospital stay, rate of CSF leaks and cranial nerve injuries （~= 4.88, t = 4.37, t = 5.09, t = -3.42, X2 = 4.07, X2 = 5.40, all P values were less than 0.05）. There were no statistical differences in the postoperative anterior pituitary deficiency, postoperative diabetes insipidus, hyposmia or postoperative epistaxis （Xz values were 1.17, 1.76, 0.03 and 0.31 respectively, and all P values of them were over 0.05）. [ Conclusion ] Endoscopic endonasal transsphenoidal surgery can effectively improve the total resection rate for giant pituitary adenomas, reduce some complications and get a shorter hospital stay compared with microscopic endonasal transsphenoidal surgery.

关 键 词：神经内镜 显微镜 巨大垂体腺瘤 

分 类 号：R651.13[医药卫生—外科学]